Provider Demographics
NPI:1992031140
Name:BETTENHAUSEN, BRITTANY (PT)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:BETTENHAUSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 GARLAND DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-2007
Mailing Address - Country:US
Mailing Address - Phone:406-439-3825
Mailing Address - Fax:
Practice Address - Street 1:2651 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-6405
Practice Address - Country:US
Practice Address - Phone:406-728-9162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2271225100000X
IDPT-2379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist